Medical Students Using Cadavers for Procedural Simulation Education

Background: Cadaver dissection remains integrated into the curriculum of numerous medical schools. Aspiring physicians acquire the opportunity to work directly with the human body, which is intricate and tangible, yet have minimal exposure to certain procedural skills applicable­­ to patient care during the first year of their medical training. Our aim was to incorporate the cadaver as part of a process to introduce procedures to a class of first year medical students in order to improve their confidence and skill in performing these procedures in patients. Methods: During medical gross anatomy at Wayne State University School of Medicine, three workshops involving common procedures performed in the emergency department were integrated into the cadaver dissection laboratory. Each educational workshop began with a short demonstration or a short step-by-step informational video on the focused procedure. The educators consisted of emergency medicine residents, third and fourth year medical student mentors, and emergency medicine attendings. Educators directed the hands-on procedure practice on the cadavers and provided real time feedback. Students completed pre and post questionnaires with scales ranging from one to five to assess the impact of the workshop on their abilities and confidence for the specified procedures. The three sessions included intraosseous (IO) line placement, joint aspiration, and chest tube placement. Results: A total of 108 students participated in the IO line training workshop, 143 students in the arthrocentesis simulation and 79 students in the chest tube session. Prior to the hands on sessions, 0 students (0%) had performed an IO line on a simulated patient, 2 students (1.4%) had performed an arthrocentesis on a simulated patient, and 4 students (5.1%) had performed a chest tube on a simulated patient. The Likert scales were viewed as ordinal variables (categorical variables) and thus the data was analyzed by Wilcoxon signed-rank test (non-parametric paired t-test). The student’s confidence in performing the specified procedure improved with a statistically significant difference in the IO, arthrocentesis and chest tube workshops (p = \u3c0.0001). There was a statistically significant increase in the perception of adequate training in all three sessions (p = \u3c 0.0001). The self-perceived skill in performing the described procedures had a statistically significant improvement for post training session in students participating in the IO, arthrocentesis and chest tube workshops (p = \u3c 0.0001). Lastly, after the hands-on educational sessions, a median of 4.5 out of 5 and mode of 5 out of 5 recommended other medical students participate in the IO simulation activity, and a median and mode of 5 out of 5 recommended the arthrocentesis and chest tube workshops. Conclusion: Workshops introducing procedural simulation in the cadaver to first year medical students improved confidence levels, perception of being adequately trained, and self-evaluated skill. Cadavers are effective models for training medical students in common emergency medical procedures. Integrating workshops into existing medical gross anatomy courses may translate into higher procedural success rates in the clinical setting, as well as stimulate interest in understanding normal anatomy and common variants encountered in practice

Patient-Reported Barriers and Limitations to Attending Diabetes Group Visits.

PURPOSE: Through this exploratory study, we sought to understand why group visit participation is low among adult patients with type 2 diabetes. METHODS: Eligible study participants included adult patients with type 2 diabetes. After a pilot survey was sent to a random sample of 48 patients, the remaining 187 eligible patients were invited to complete a revised version of the survey. RESULTS: Most frequently cited reasons for not attending group visits included diabetes under control, work and/or other responsibilities, and time barriers. There was variability in the desired time for the visits, though the majority of patients preferred evening visits. While some patients reported copays as a challenge, the likelihood of attending did not decrease for this subgroup. Most patients surveyed (54%) indicated interest in diabetes group visits. CONCLUSION: Implementing strategies to address the patient-identified system barriers (eg, time, transportation, and copays) may increase participation in diabetes group visits

Expression of green fluorescent protein in human foreskin fibroblasts for use in 2D and 3D culture models

ABSTRACT The availability of fibroblasts that express green fluorescent protein (GFP) would be of interest for the monitoring of cell growth, migration, contraction, and other processes within the fibroblast-populated collagen matrix and other culture systems. A plasmid lentiviral vector-GFP (pLV-GFP) was utilized for gene delivery to produce primary human foreskin fibroblasts (HFFs) that stably express GFP. Cell morphology, cell migration, and collagen contraction were compared between nontransduced HFFs and transduced GFP-HFFs; no differences were observed. Immunocytochemical staining showed no differences in cell morphology between nontransduced and GFP-HFFs in both two-dimensional and three-dimensional culture systems. Furthermore, there was no significant difference in cellular population growth within the collagen matrix populated with nontransduced vs. GFP-HFFs. Within the limits of our assays, we conclude that transduction of GFP into HFFs did not alter the observed properties of HFFs compared with nontransduced fibroblasts. The GFP-HFFs may represent a new tool for the convenient monitoring of living primary fibroblast processes in two-dimensional or three-dimensional culture. Since the 1980s, the fibroblast-populated three-dimensional (3D) collagen matrix (FPCM) culture system has been used to model wound contraction, 1,2 cellular migration/motility, 1,3 and other phenomena. The cells exert tension on the matrix 4 and in some cases develop a myofibroblast phenotype similar to that in some healing wounds. 2,5 Although the FPCM model may be more physiologically relevant than a two-dimensional (2D) cell culture model, use of the former has been associated with a number of technical issues, such as reagent molecule absorption to collagen, interference of the collagen with protein assays, and obfuscation of cellular morphology in living (unstained) samples. 6 This latter issue makes tracking of living cells within the collagen matrix difficult. The ability to track living cells within the 3D collagen matrix would facilitate the study of fibroblast migration and motility; such an ability would be relevant to chemotaxis, granulation tissue formation, wound contraction, and other healing-related phenomena. 9 Green fluorescent protein (GFP) has been used as a marker or gene activity and asa label for proteins and subcellular compartments within living cells. 10 In addition, GFP-labeled cells can be tracked in tissues and used in numerous GFP-based biochemical sensor applications. 11,12 The availability of stable GFP-expressing primary human fibroblasts would be useful for studying cell growth, migration, and contraction within the 3D collagen matrix model. The purpose of the present report was to determine whether GFP expression affected select fibroblast functions and to investigate possible applications of GFP-expressing fibroblasts in 2D and 3D in vitro culture systems

Qualitative Exploration of Geospatially Identified Bright Spots and Priority Areas to Improve Diabetes Management.

BACKGROUND: Type 2 diabetes (T2DM) results in significant morbidity and mortality and is associated with disparities in prevalence, treatment, and outcomes. GIS can identify geographically based disparities. In the focused Rapid Assessment Process (fRAP)-a novel mixed-method study design-GIS is combined with qualitative inquiry to inform practice interventions and policy changes. METHODS: Using fRAP, areas with poor T2DM outcomes (priority areas) as well as areas with positive T2DM outcomes (bright spots) were identified, focus groups were conducted, and responses analyzed for intervention opportunities. Focus group participants were English- and Spanish-speaking patients with T2DM living in one of the identified areas. Qualitative analysis consisted of initial coding with a priori themes from the focus group question guide, followed by identification of emergent themes within each defined category. RESULTS: The a priori categories included Facilitators, Barriers, Strategies, and Impact of Diabetes Diagnosis. Emerging recurrent themes were Interactions with Medical Professionals, Medications, Lifestyle Management, Family Motivators and Support, Self-Efficacy, and Social Needs and Community Resources. CONCLUSIONS: Thematic results from focus groups can be used by practices to improve T2DM care through educating patients about chronic disease and nutrition, connecting them to diabetes-specific services, learning how diabetes fits in the context of patient lives, and eliciting patient values and motivations to improve diabetes self-management. Findings also may be used by health care professionals to inform community-based advocacy efforts, interventions, and future research

How a Diverse Research Ecosystem Has Generated New Rehabilitation Technologies: Review of NIDILRR’s Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a “total approach to rehabilitation”, combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970’s, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program